home
***
CD-ROM
|
disk
|
FTP
|
other
***
search
/
CD-ROM Today (UK) (Spanish) 15
/
CDRT.iso
/
dp
/
0371
/
03712.txt
< prev
next >
Wrap
Text File
|
1994-01-17
|
9KB
|
209 lines
$Unique_ID{BRK03712}
$Pretitle{}
$Title{Eosinophilia Myalgia}
$Subject{Eosinophilia Myalgia L-Tryptophan Disease Eosinophilic Myalgia
Tryptophan Disease Tryptophan Syndrome Scleroderma Trichinosis Toxic Oil
Syndrome Eosinophilia Fasciitis}
$Volume{}
$Log{}
Copyright (C) 1990, 1991, 1992 National Organization for Rare Disorders,
Inc.
783:
Eosinophilia Myalgia
** IMPORTANT **
It is possible that the main title of the article (Eosinophilia Myalgia)
is not the name you expected. Please check the SYNONYM listing to find the
alternate names and disorder subdivisions covered by this article.
Synonyms
L-Tryptophan Disease
Eosinophilic Myalgia
Tryptophan Disease
Tryptophan Syndrome
Information on the following diseases can be found in the Related
Disorders section of this report:
Scleroderma
Trichinosis
Toxic Oil Syndrome
Eosinophilia Fasciitis
General Discussion
** REMINDER **
The information contained in the Rare Disease Database is provided for
educational purposes only. It should not be used for diagnostic or treatment
purposes. If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.
Eosinophilia Myalgia Syndrome is a disorder associated with the oral use
of large doses of tryptophan (also known as L-Tryptophan), a dietary
supplement often sold in health food stores. It is a disease of abrupt onset
causing severe, disabling, chronic muscle pain, skin symptoms and other
neurotoxic reactions. It can be diagnosed by finding unusually high levels
of eosinophils in the blood (white cells).
Symptoms
Eosinophilia Myalgia Syndrome occurs weeks, months or even years after the
oral use of tryptophan. A contaminant in the manufacturing process for some
suppliers is suspected in causing the disorder. L-tryptophan is an
essential amino acid present in most foods. When purchased as a "health
food" people take unusually high doses of L-tryptophan which would not
ordinarily be present in the normal diet. The disorder is characterized by
large amounts of eosinophils (white blood cells) in the blood. The primary
symptom is severe muscle pain and weakness. There may also be associated
ulcers of the mouth or other mucous membranes. Sore throat, difficulty
breathing (dyspnea), swollen liver and abdomen, abdominal pain and fever may
also be present.
Skin abnormalities resembling Scleroderma including swelling and
tightening of the skin, painful itching, and pitting and edema along with
peau d'orange skin of the legs may also occur. The skin symptoms usually
start in the extremities (usually the legs) with the upper body becoming
involved later if at all.
A long term problem of sensorimotor polyneuropathy is evident in sixty-
one percent of EMS patients.
Causes
Eosinophilia Myalgia may be caused by the ingestion of some lots of oral
L-tryptophan. Tryptophan is an essential amino acid present in very small
quantities in most foods. However, the amounts ingested by patients with
Eosinophilia Myalgia are over and above the amounts occuring naturally in
food. The drug was formerly available at health food stores without
prescription as a dietary supplement. Although there was no proof of
effectiveness, many patients used it to treat depression, premenstrual
syndrome and insomnia. During 1990 the FDA removed tryptophan from the
shelves of stores and it can no longer be purchased in this country.
Scientists are still trying to determine whether the tryptophan itself causes
predisposed persons to manufacture neurotoxins that cause Eosinophilia
Myalgia symptoms, or whether the tryptophan is in some way contaminated in
the manufacturing process.
Scientists now believe they can confirm that L-tryptophan itself causes
symptoms of EMS in patients who use the product. Further studies have shown
that L-tryptophan contaminated with 1-1-ethylidenebis (ETB) causes more
severe problems in people than regular L-tryptophan; still, L-tryptophan
alone can cause EMS.
Affected Population
Eosinophilia Myalgia seems to affect males and females in equal numbers. The
Centers of Disease Control states that as of February, 1990, 1269 cases were
reported to them. Some patients have died.
Related Disorders
Symptoms of the following disorders can be similar to those of Eosinophilia
Myalgia. Comparisons may be useful for a differential diagnosis:
Scleroderma refers to a group of chronic disorders characterized by
fibrosis, degenerative changes, and vascular abnormalities in the skin.
Scleroderma is the chronic hardening and shrinking of the connective tissues
of any part of the body, although the term literally means "hardening of the
skin." (For more information on this disorder, choose "Scleroderma" as your
search term in the Rare Disease Database).
Trichinosis is a disorder that is caused by the parasitic round worm
Trichinella spiralis. Persons become infected by eating raw or undercooked
pork that contains cysts of the parasite. The symptoms include swelling of
the eyelids, and mucous membranes. Aching of the muscles, fever, and
increasing weakness may also be present.
Toxic Oil Syndrome was an epidemic disorder associated with the eating of
contaminated cooking oil that swept Spain during the summer of 1981 and
affected over 20,000 persons. Its features were an initial phase of fever
and pneumonitis, then gastrointestinal dysfunction and severe eosinophilia,
severe myalgia, muscle contractures and severe muscular pain.
Eosinophilic Fasciitis commonly occurs in the fourth to sixth decades of
life. The initial symptoms may include pain, swelling and inflammation of
the skin, which usually takes on a characteristic orange-peel appearance.
The arms and forearms are affected more often than the thighs and legs. Arm
and leg movements gradually become restricted. Inflammation of the tendons
often leads to contractures of the fingers and Carpal Tunnel Syndrome. Onset
of Eosinophilic Fasciitis has, in some cases, been related to the ingestion
of the dietary supplement tryptophan. Symptoms most commonly follow strenuous
physical activity. (For more information on this disorder, choose
"Eosinophilic Fasciitis" as your search term in the Rare Disease Database).
Therapies: Standard
Treatment of Eosinophilic Myalgia consists of high doses of glucocorticoids
(Hydrocortisone) to reduce the amount of circulating eosinophils. This
treatment, however, does not usually improve the other symptoms.
Therapies: Investigational
Research on Eosinophilic Myalgia is ongoing. For more information about
investigational therapies contact the Centers for Disease Control listed
below.
This disease entry is based upon medical information available through
July 1991. Since NORD's resources are limited, it is not possible to keep
every entry in the Rare Disease Database completely current and accurate.
Please check with the agencies listed in the Resources section for the most
current information about this disorder.
Resources
For more information on Eosinophilia Myalgia, please contact:
National Organization for Rare Disorders
P.O. Box 8923
New Fairfield, CT 06812-1783
(203) 746-6518
EMS Support Group
c/o Television Workshop
3637 Green Rd.
Beachwood, OH 44122
NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases
Information Clearinghouse
Box AMS
Bethesda, MD 20892
(301) 495-4484
Centers for Disease Control
1600 Clifton Road, NE
Atlanta, GA 30333
404-639-3534
Scleroderma Foundation
1725 York Avenue, Suite 29F
New York, NY 10123
212-427-7040
References
CITY HEALTH INFORMATION, A Publication of the New York city Department of
Health, Vol. 9, No. 1, January, 1990.
INTERIM GUIDANCE ON THE EOSINOPHILIA-MYALGIA SYNDROME, Editorial, Annals
of Internal Medicine ( January 15, 1990, issue Vol. 112 No. 2).
ASSOCIATION OF THE EOSINOPHILIA-MYALGIA SYNDROME WITH THE INGESTION OF
TRYPTOPHAN, Philip A. Hertzman, et al.; New England Journal of Medicine,
(March 29, 1990, issue 322, (13)). Pp. 869-87873.
SCLERODERMA, FASCIITIS, AND EOSINOPHILIA ASSOCIATED WITH THE INGESTION OF
TRYPTOPHAN. Richard M. Silver, et al.; New England Journal of Medicine,
(March 29, 1990, issue 322, (13) ). Pp. 874-881.
TRYPTOPHAN-INDUCED EOSINOPHILIA-MYALGIA SYNDROME. Editorial Board, New
England Journal of Medicine, (March 29, 1990, issue 322, (13)). Pp. 926-928.
Article on L-Tryptophan use and EMS featured in the October 10, 1991
issue of NATURE, P. 490.